LP 312 
.M6 A3 
no. 4 
Copy 1 



Keeping the Children Well 



Medical Inspection; School Nurses; the 
Open Air School; Open Air Rooms 




City of Minneapolis 
December, 1916 



A SERIES OF MONOGRAPHS 

EACH TREATING SOME PHASE OF THE 
MINNEAPOLIS PUBLIC SCHOOLS 



These monographs are designed to take the place of con- 
ventional annual or biennial reports. 

1. A Million a Year. 

A five-year building program, including a discus- 
sion of policies concerning junior high schools, 
extending the normal capacity of the school plant 
and the establishment of standard distances for 
the location of school buildings. 

Issued, September, 1916 

2. Financing the Minneapolis Schools. 

Sources of revenue; expenditures. 

Issued, September, 1916 

2a. The Price of Progress. 

Legislative program of the Board of Education; 
calls for the authorization of increased revenues 
through tax levies and bond issues, and the inde- 
pendence of the Board of Education in fixing the 
tax rate for educational purposes, subject only to 
maximum rates established by the Legislature. 

Issued, November, 1916 

3. Where Are the Children? 

Describes a continuous census taken and kept by 
the schools; also means of securing regular 
attendance. 

Ready, January, 1917 

4. Keeping the Children Well. 

Medical inspection; school nurses; the open air 
school; open air rooms. 

Issued, December, 1916 

5. In a Major Key. 

Music in the Minneapolis Schools. 

Issued, December, 1916 

6f Pencil and Brush. 

Art in the Minneapolis Schools. 

Issued, November, 1916 

7. Wider Use of the School Plant. 

Ready, January, 1917 

Ready, January, 1917 



8. Operation of the School Plant. 

9. Out of the Beaten Track. 



School publications; entertainments; festivals; 
various activities not in the regular curriculum. 

Read}', January. 1917 

(Continued on inside back cover) 



BOARD OF EDUCATION 

CITY OF MINNEAPOLIS 

The last tivo paragraphs of Section VIII on page 32 of 
Monograph, "Keeping the Children Well ," refer to the Open 
Air school and should be the concluding paragraphs of 
Section VII, page 2Q. 

{January, iqij) 



Keeping the Children Well 



Medical Inspection; School Nurses; the Open Air 
School; Open Air Rooms 



Ifc 



Monograph Number 4 
Series of 1916-17 



Ordered Published by the Board of Education 
City of Minneapolis, December, 1916 






Under the general direction of the 

Superintendent of Schools 

this monograph was 

prepared by 

CHARLES H. KEENE, M. D. 

Director of Hygiene and Physical Education 

Minneapolis Public Schools 

D. of D. 
FEB f 1917 



<5- 






CONTENTS 

Page 

Introduction v 

I. Health Supervision 1 

II. Heating and Ventilating 14 

III. Drinking Water 19 

IV. Toilets and Floors 21 

V. Lighting in Classrooms 23 

VI. Seating of Classrooms 25 

VII. Open Air Schools 27 

VIII. The Penny Lunch and the Penny Breakfast 30 

Appendix — 

A. History of Medical Inspection in Minneapolis and Else- 

where 33 

B. Why School Health Supervision Should be Carried on 

By the Board of Education 35 

C. Rules Regarding School Physicians 37 

D. Rules Regarding School Nurses 38 

E. Distribution of Expenditures for Health Supervision in 

1915-16 39 

F. Progress of Children in Open Air Schools 40 

G. Financial Statement of Penny Lunches for 1915-16 41 

Illustrations — ■ 

A School Nurse's Room 3 

Bathing Facilities in the Grant School 6 

The Dental Clinic in the Blaine School 8 

Pivot-hung Windows in the Thomas Arnold School 17 

Pupils Lined Up for Their Turn at a Drinking Fountain 20 

Modern, Sanitary Toilets such as are Installed in the Min- 
neapolis Schools 22 

Children Take Naps with Open Windows, Thus Learning One 

of the First Laws of Health 28 

Clean, Nourishing Food in Small Amount is the Daily Pro- 
gram in Certain Schools. This is a Scene at the Thomas 
Arnold 31 



Board of Education 

City of Minneapolis, Minnesota 
1915-16 

Members 

Horace N. Leighton - President 

Cavour Langdon ------ Secretary 

Alex G. Bainbridge Harington Beard 

Arthur F. Benson Henry Deutsch 

Mae Snow 

Frank E. Spaulding ----- Superintendent 
Charles M. Jordan - Superintendent Emeritus 

Assistant Superintendents 

Catherine T. Bryce Elizabeth Hall 

John N. Greer, advisory on high schools 

Bennett B. Jackson Flora E. Pope 

William F. Webster 

George F. Womrath, for business affairs 



INTRODUCTION. 



What is the Department of Hygiene attempting to do toward 
supervising the health of fifty thousand public school pupils in 
Minneapolis ? Perhaps the most prominent phase of efforts along 
this line falls under the head of what was commonly called "Med- 
ical Inspection." This was a very good term at the time such 
work was started in the United States, 1 but it has become a very 
poor one because the scope of the work has come to include so 
much more than merely inspection for disease. "Health Super- 
vision" is a much broader and more descriptive term. 

Under the head of health supervision is included the work 
carried on in the school buildings by school physicians, school 
nurses, school dentist and bath attendants ; also open air schools, 
open window rooms, school lunches and sanitary inspection of 
school buildings. Sanitary inspection covers such things as ven- 
tilation, drinking fountains, toilets, cleaning, lighting, seating and 
any other matters that pertain primarily to checking any condi- 
tions that may tend to break down the vitality of the children 
and thus render them more susceptible to infectious or con- 
tagious disease, or to hinder school progress. 2 

Health supervision purposes, not primarily treatment of dis- 
ease, but prevention of the occurrence of conditions which may 
cause or permit the spread of contagious or infectious disease, 
or conditions which may lead to the lowering of the vitality of 
children ; in other words, protection of every individual in the 
schools. The specific objects are: 

First : the prompt discovery, day by day, of acute illnesses 
which may be of a contagious type, and the removal of pupils 
having these illnesses from contact with their schoolmates ; 

Second : the prompt discovery of uncleanly conditions among 

*For the history of medical inspection in Minneapolis and elsewhere, see 
Appendix A. 

2 Efforts in physical education will be considered in a later monograph, as will 
handling of special classes for the deaf, stammerers, the blind and subnormal pupils. 



pupils, and the putting of these pupils in proper condition to 
mingle with others ; 

Third: the discovery, and reporting to parents or guard- 
ians, of physical defects which may serve as impediments to the 
symmetrical development of the child, and therefore to proper 
school progress ; 

Fourth : the discovery of cases of retarded mental develop- 
ment, which are causes of deficient school work and a detriment 
to the work of the teacher and of the normal pupils in the class ; 

Fifth : frequent sanitary inspection of the school rooms and 
of the school buildings as a whole, and the immediate removal 
of any insanitary conditions found. 

Thus health supervision is an educational problem. All 
problems relating to heating and ventilating, cleaning, matters 
like location and equipment of toilets, the kind of page and type 
to be used in the schools, the hours of study and recreation, are 
almost entirely educational problems. The question of whether 
a child is in proper physical condition so that he may participate 
in gymnastic work or take part in the organized plays and games 
and athletics is largely an educational problem. Whether his 
hearing is so poor, his vision so weak, his speech so peculiar, or 
his lungs so diseased that he needs assignment to a special class 
concerns the educational authorities much more than any others. 1 



!For discussion of the reasons for having school health supervision under direction 
of the Board of Education, see Appendix B. 



I 

HEALTH SUPERVISION 



When medical school inspection was tried out in Minneapolis 
in a preliminary way in the winter of 1909, it was found that 
forty-nine pupils out of the first one hundred fourteen examined 
had lost a total of 60.5 years because of failure to advance regu- 
larly in school. These forty-nine all showed marked physical 
defects. 

Undoubtedly, too, the amount of contagious disease, given 
an adequate amount of help, may be cut down markedly by a 
properly handled system of health supervision. This has proved 
true in many cities. In communities where the reporting of con- 
tagious disease is thoroughly effective, the records show there is 
less contagious disease when schools are in session than during 
the long summer vacation. 

For several reasons the amount of contagious disease in 
Minneapolis is usually greater than it should be. Most prom- 
inent among the reasons probably is the sentiment in the com- 
munity which does not force strict and adequate quarantine of 
contagious diseases. Until very recently the contagious depart- 
ment of the city hospital has not had an adequate number of 
beds to take care of all those cases of contagious diseases which 
should be isolated. This, too, has had bearing on the amount of 
contagious disease. 

At present, the group concerned primarily in the work of 
health supervision here consists of eight physicians, twenty-nine 
nurses and three bath attendants. 

School Physicians 

The school physicians, under the rules of the Board of Edu- 
cation, are "to seek to promote the health of the pupils." 1 While 

—l— 



KEEPING THE CHILDREN WELL 

4 

it is essential that these physicians have high professional qualifi- 
cations, it is probably equally important that they be chosen for 
strength of personality, character, their love of humanity, spe- 
cial qualifications and a desire to deal with children of school age. 

Each physician has a combination of school districts, with 
approximately six thousand children, including those in the high 
schools, under his charge. This number is too large for him to 
make physical examinations of each pupil often enough to keep 
the teacher accurately informed of the physical condition of her 
pupils, or for him to get any intimate knowledge of the pupils 
under his care, or to know the peculiarities of the districts with 
which he has to deal. 2 

Even under present conditions, services of the school physi- 
cians have been valuable, as is shown not only by the dependence 
that is placed upon them by school teachers and principals, but by 
the rapidly increasing numbers of parents who come to the school 
to consult with them in regard to their children. The number 
of these consultations increased during- the last school year 30 
per cent. This rapidly increasing contact between the parent and 
the school is of great value from every point of view. 

School Nurses 

As required by the rules of the Board of Education, school 
nurses "assist the physician in the examination of children, and 
seek to promote the health and well-being of the children in the 
district." 3 

With the nurses, even more than with the physicians, the 
question of personality is of extreme importance. Not only must 
the nurse have great tact and judgment in her intimate dealings 
with the families of her district, but she must be supremely inter- 
ested in the sociological side of the problem with which she has 
to deal. She must be not only a woman of judgment, executive 



] See Appendix C. 

2 Because of the rapidly increasing amount of interest in public health work, 
it is probable that the time has arrived when it is possible to obtain full-time physicians 
who might be more specially trained for school health work, and who, because of their 
full-time service, would take a deeper interest in the work. Eight full-time employees 
would give much more efficient service than is given under the present arrangement. 

•"-See Appendix D. 




< 



4 KEEPING THE CHILDREN WELL 

power and professional expertness, but one whose intelligence 
is well balanced by humanistic impulses and a supreme desire to 
help. 

Her duties often include early morning inspection for pos- 
sible contagious disease ; emergency treatment of pupils who may 
be injured in or about the school premises ; assistance to the school 
physician in making physical examinations ; visits to the homes 
of children who have been absent three days, such visit often 
developing the fact that they are ill with contagious disease or 
are truants ; taking of pupils, at the request of parents, to the 
free dispensary for treatment ; bathing of children where proper 
facilities for cleansing outside the school may be lacking ; l visits 
to homes to explain to parents the need for glasses or for the cor- 
rection of other physical defects, or to persuade parents to send a 
pupil to some one of the special classes or to the open air school, 
or to persuade them to make greater efforts towards cleanliness 
of the skin and scalp ; or even attendance at juvenile court in order 
to explain to the court the need of action looking to protection 
of neglected children. She also reports to the Health Department 
suspected cases of contagious disease, insanitary premises, alleys, 
or out-houses which she may find in her district, and to the State 
Board of Health special data relating to uncommon epidemics. 

The ordinary daily routine of the school nurse is first to 
give attention, in a certain number of schools, to children who are 
suspected of having contagious disease or who, on various counts, 
are professing to be ill ; next to assist the school physician 
in making physical examinations. Afternoons are devoted almost 
entirely to visiting the homes of children who have been absent 
three days or more, visiting to urge correction of defects of chil- 
dren, taking them to dispensaries for treatment or to assisting 
the school dentist in the school dental clinic. Some time is neces- 
sarily used to keep the records in order. 

The nurse also collects information which may aid the Hu- 
mane Society 2 in a proper disposition of cases relating to children 



iGiving the supervision of bathing to the nurse rather than to a special bath 
attendant decreases the size of the nurse's district, thus saving a great amount of time 
by decreasing the distances she has to travel. 

2 After January 1, 1917, the newly created Children's Protective Society will 
take charge of the child welfare work that has been done by the Minneapolis Humane 
Society and the Juvenile Protective League of Hennepin County. 



HEALTH SUPERVISION 5 

under its charge. In brief, she is a nurse, a sanitary inspector 
and a social investigator combined. The value of her services 
not only to the teacher and to the employees of the Board of 
Education, but to the pupils and the city at large, is inestimable. 
The district varies in size from one thousand to eighteen 
hundred pupils, depending somewhat upon the nature of the dis- 
trict but more particularly upon whether or not she is expected 
to give a large part of her time to supervision of school bath- 
ing, or to supervision of the special health work, as at the open 
air school, or whether or not part of her time is given to service 
at the school dental clinic. 

Bath Attendants 

Bath attendants give full time from 8 :30 a. m. to 3 :30 p. m. 
As their contact with the children is quite intimate, it is neces- 
sary that they be persons of cleanly habit and good influence, 
with a great amount of tact and a real love for children as well 
as considerable executive and disciplinary ability. They super- 
vise the work in the school bath rooms. At present there are 
three full-time bath attendants. 

It is the policy of the Board gradually to have all the bath 
work taken over by the school nurse for reasons mentioned, 
except where a center is large enough so that the bath attendant 
is busy all the time in one building. 

School baths are provided for at the Blaine, Bremer, Clay, 
Emerson, Franklin, George Bancroft, Grant, Harrison, Hiawatha, 
Holland, Horace Mann, John Ericsson, Lyndale, Margaret Fuller, 
Peabody, Schiller, Seward, Simmons, Sumner, Thomas Arnold, 
Thomas Lowry, Washington and William Penn schools. Six of 
these schools, the Clay, Harrison, Sumner, Thomas Arnold, 
Thomas Lowry and William Penn, are under the supervision of 
bath attendants ; the others are handled by school nurses as part 
of their regular work. 

Bathing facilities of some sort ought to be in every school 
building, especially if there is a gymnasium. While the equip- 
ment of these bath rooms is expensive because of the cost of 
plumbing, the maintenance cost is moderate. The five bath attend- 
ants on full time last year gave during the year 47,590 baths, 




c 

~~r. 



> 









o 



- 



HEALTH SUPERVISION 7 

at a cost of $3,090. This is a cost per bath of six and one-half 
cents. 

The Dental Clinic 

The dental clinic has been maintained during most of the 
last two years at the Blaine School, three afternoons a week. 
The first year this was supported by the Minneapolis District 
Dental Society. Since January 1, 1916, it has been financed by the 
Board of Education. The number of treatments averages about 
825 a year, at an average cost of forty-eight cents a treatment. 1 

Every precaution is taken to see that those children receiv- 
ing free service at the clinic not only need the service, but are 
unable to pay for private service. 

The total cost of this service of health supervision last year 
was $28,361. 2 This gives a pupil cost of sixty-one cents a year. 

Benefits Detailed 

What benefits is the community deriving or may it expect 
to derive from this expenditure? Undoubtedly the amount of 
contagious disease is diminished by the presence of school physi- 
cians in the schools. This is so, first and primarily, because they 
detect cases of contagious disease, both in routine inspection work 
and in the classroom inspection which is held whenever it is felt 
that the conditions are such as to warrant special care and pre- 
cautions. 

In 1909-10, there were 2,765 exclusions for contagious dis- 
ease in six months of the school year. This indicates a contagious 
disease rate for that year of approximately 10 per cent; that is, 
one child in ten in the schools had some contagious disease. In 
the last three years, this has averaged only 6 per cent a year. 

The amount of contagious disease is diminished secondly, 
because certain persons are much more careful about sending 
their children to school when there is any possibility of their 



iOf course, this amount of dental service is wholly inadequate for a school 
system of fifty thousand pupils. There should be at least three full-time dental clinics. 
If there were three, one should be located at the Blaine School, one on the East Side 
and one in South Minneapolis. Three would cost $5,000 a year. 

2 See Appendix E. 



HEALTH SUPERVISION \) 

having contagious disease. This often results in obtaining proper 
medical help in the home when a child is attacked with an acute 
illness, so that not only is a certain amount of contagious disease 
prevented, but the children are given proper care at the onset of 
disease, this proper care often meaning the difference between 
a permanent defect and a normal child, between recovery and not 
recovery. 

Then, too, the number of physical examinations which are 
being made and the number of physical defects which are being 
called to the attention of the parents result in cutting down the 
amount of physical defects found in the schools. This diminu- 
tion is brought about largely in two ways ; first, by the removal of 
defects found by the school physician ; second, as the parent is 
aroused to self-help, by the removal of defects early in life before 
the child reaches the school physician. So one finds for the last 
five years a steadily diminishing percentage of children having 
defects. This means an immense increase in the well-being of 
the children and in the scholastic results obtained by the same 
amount of effort on the part of the teacher. 

Moreover, the monthly, and sometimes more frequent, in- 
spections of buildings which the school physicians conduct result 
in a much better upkeep from a sanitary point of view. This is 
not only because those mainly responsible for the care of build- 
ings are much more careful in their work when they know this 
inspection is to be made, but because insanitary conditions found 
are reported to the central office, thence to the business office, 
and these conditions corrected as rapidly as funds permit. The 
changes that have taken place in the schools in the last five years 
as the result, to some extent, of these frequent inspections will be 
treated later. 

The nurses, too, have a marked effect upon all these things 
as well as upon some others. On the cleanliness side, it may be 
noted that since the school year 1913-14, when for the first time 
the whole city was covered, the occurrence of pediculosis has 
decreased from 19,5 per cent that year to 8.5 per cent in 1914-15, 
and to 6.5 per cent in 1915-16. 

In the daily inspections for contagious diseases which the 
nurses carry on, many of these cases are found and excluded 



10 KEEPING THE CHILDREN WELL 

from school before they have an opportunity to infect their school- 
mates. In the last three school years, the nurses took 14,975 
cultures of suspicious sore throats, of which 794 were found to 
be cases of positive diphtheria. These cases probably would not 
have been found at all, or at least only after they had infected a 
large number of pupils, if the nurse had not been on the ground 
to take these cultures immediately when suspicion arose. These 
794 cases constituted 55 per cent of all the cases of diphtheria 
reported among children in the public schools in that time. In 
those three years, the incidence of diphtheria among school chil- 
dren fell from 1.17 per cent in 1913-14 to .93 per cent in 1914-15, 
thence to .55 per cent in 1915-16. Scarlet fever has shown a sim- 
ilar decrease. This is sufficient evidence of the value of the nurses' 
work in checking contagious disease. 

It is of no great value to the Board of Education, to the 
parents or to the community, to know that from 65 to 75 per 
cent of the pupils have some kind of physical defect. The only 
real value in having that information comes from getting these 
defects removed. The nurses are very largely the responsible 
parties in getting defects removed, because it is only after a visit 
to the home by the nurse and a careful explanation to the par- 
ents of the needs and advantages of removal of these defects 
that action is induced on the part of the parents. 

It is to be remembered that the school physicians and nurses 
give no treatment except in emergencies ; sometimes, however, 
treating conditions of filth and vermin. A few cases receive treat- 
ment in the dental clinic. Parents are advised to obtain treatment 
from their own physician or dentist. In other words, parents are 
expected to take care of their own children whenever possible, 
the community stepping in with free treatment only when proper 
care of the children is not otherwise possible. 

At present, figures are available for six consecutive years 
of inspection. In those six years 70,899 pupils have been exam- 
ined. Although inspection covered only 33 per cent of the pupils 
enrolled in the schools the first year, 51 per cent the second and 
80 per cent the third, the figures show certain interesting trends. 
In addition to 150,000 inspections yearly for contagious disease, 
each year from 7,000 to 15,000 pupils have been examined, 
depending upon the number of physicians employed and the 



HEALTH SUPERVISION 11 

amount of contagious disease or other things that interfere with 
making physical examinations. 

In general, the number of physical defects found has de- 
creased from 71.7 per cent in the school year 1910-11 to 62.8 per 
cent in 1915-16. 

A study of individual factors shows that those things which 
are dependent on school hygiene and upon the educating of par- 
ents almost universally decreased. For instance, malnutrition 
has decreased from 6.9 to 3.7 per cent; anemia has decreased from 
11.7 to 4.5 per cent. Here, probably more than anywhere else, 
the results of the efforts of the school nurses in the education of 
the parents in proper dietetics and home hygiene are seen. 

Defective vision has decreased from 18.1 to 15.4 per cent. 1 
Defective hearing has decreased from 3.7 to 2.1 per cent, dis- 
charging ears from 1.2 to .9 per cent. As a commentary 
on these two decreases, it is interesting to note that during the 
last four years, in which most of this decrease has taken place, 
scarlet fever, which was responsible for so much defective hear- 
ing and middle ear disease, has decreased from 1 per cent in 
1912-13 to .4 per cent in 1916, a decrease of 60 per cent. 

The percentage of tooth defects has varied from year to 
year. Most of this variation, however, took place before the 
last three years, when a large percentage was being added to the 
number of pupils under inspection. In the last three years there 
has been practically no variation, the percentage of untreated 
defects ranging from 38.1 per cent of those examined, as a mini- 
mum, to 38.8 as a maximum, the defects reported being those 
usually observed by ordinary mouth inspection. 

Hypertrophied tonsils have decreased from 34.7 to 25.9 per 
cent. Abnormal adenoid growth has decreased from 28.7 to 20.2 
per cent. 

This diminution of the number of apparent defects all along 
the line is very gratifying. It means probably not only that 
school conditions are better than six or seven years ago, 
but that the parents are co-operating more and more with the 
school, and getting defects corrected before their children come 
into the hands of the school physician. 

!See page 24. 



12 KEEPING THE CHILDREN WELL 

As gratifying as these figures are, there is one set of figures 
in the compiled statistics for the six years that calls for special 
thought and consideration. This set discloses that the percentage 
of nervous diseases has more than doubled in the last few years, 
having risen from .7 per cent in 1910-11 to 1.6 per cent in 1915-16. 

The figures showing this increase were .7 per cent in 
1910-11, 1 per cent in 1911-12, .7 per cent in 1912-13, .9 in 1913- 
14, 1.1 in 1914-15 and 1.6 in 1915-16. 1 

The cause of this steady increase during the last few years 
has not yet been determined definitely. 

It is to be remembered that the nurse is in the building every 
day, that the general conditions relating to health come under 
her trained eye almost continuously. This must result in con- 
siderable increase in care in cleaning matters, in proper ventila- 
tion, particularly at those times when the fans of the heating plant 
are not running, and in a proper observation of the rules of the 
Board of Education which demand that all pupils shall be sent 
from the building at recess time. 

Not only are the nurses in the building every day, but, trav- 
eling through the district day after day, almost entirely on foot, 
they are continually taking short cuts through vacant lots, alleys, 
and the like, which bring them into positions for observation of 
backyards, outhouses, and so on. The results are frequent reports 
to the Health Department of insanitary conditions in the com- 
munity, such as the dumping of garbage in backyards, courts and 
alleys, failure to comply with the city ordinance which requires 
connection of toilets with the sewer when sewer is in the street, 
of uncleanliness in corridors, and the like, in apartment buildings, 
and of numerous other things which are often neglected by 
both tenants and landlords. These things mean the difference 
between a healthful condition in the community and a disgusting, 
unhealthful one. 

The rule which requires the teacher and principal to report to 
the nurse, and the nurse to visit, those children who have been 
absent three or more days, brings the nurse frequently into the 



iSeventeen per cent of the cases found were in the first grade, 16 per cent 
in the second, 15 per cent in the third, 16 per cent in the fourth, 12 per cent in the 
fifth, 8 per cent in the sixth, 12 per cent in the seventh and 1 per cent in the eighth. 



HEALTH SUPERVISION 13 

homes, where she often finds children who are sick either from 
contagious disease or from illnesses which may be brought about 
by insanitary conditions in the house. She often finds children 
who are being kept out of school for lack of proper shoes and 
clothing, and sometimes, possibly, even for lack of proper food. 

Finding of these conditions, and so far as possible, remov- 
ing them, results not only in helping to keep the children well, 
and therefore cutting down the amount of absence, but it checks 
very markedly the tendency towards truancy, which is quite 
strong in some neighborhoods. The parent realizes that in two or 
three days the nurse will visit the home, and therefore it is not 
practicable to keep the child home for other than necessary 
reasons. 

This latter visiting brings about an intimate relationship 
between the Department of Hygiene and the Department of 
Attendance, which is most advantageous to both departments. 
It cuts down considerably the amount of unnecessary absence and 
brings many children back into school who are potentially truants, 
thus making it unnecessary for any officer of the attendance 
department to look up these children. 

This co-operation is advantageous to the Department of 
Hygiene in that it brings back into school in a cleanly condition 
many pupils whose parents have refused to accede to the nurse's 
repeated requests that they keep their children in a sufficiently 
cleanly condition so that they may associate decently with their 
schoolmates. Such coercion not only puts the children in cleanly 
condition, but certainly puts them in a more healthful one, so that 
their attendance in school is more nearly continuous, and their 
vitality is increased. These two things, regular attendance and 
cleanliness, tend toward a much more rapid and satisfactory prog- 
ress in school work. Lastly, too, there must result an increased 
self-respect which makes for good citizenship. 



II 

HEATING AND VENTILATING 



The Department of Hygiene has carried on, from time to 
time, special studies on certain phases of its problem. Perhaps 
one of the most urgent needs was, and possibly still is, the arriv- 
ing at a proper basis of heating and ventilating. 

Mere pouring into a classroom of a certain volume of 
air, heated to a certain temperature, is not a complete solution of 
the problem. It is necessary that the dispersal of air from the 
intake duct shall be such as not to cause any draft upon the pupils, 
and that this air shall be not only properly warmed, but properly 
moistened. 

Air that is dry enough to draw moisture from the^ furniture 
certainly causes a condition of the mucous membrane of the 
respiratory passages that makes children particularly susceptible 
to diseases of those passages, and probably accounts in large 
measure for the many severe colds that children have during 
school terms. 

Outdoor air raised from zero degrees to seventy degrees has 
only one-third to one-fourth the amount of moisture it should 
have. Such air poured into a classroom without any effort to- 
wards moistening it is going to get moisture even if it does it at 
the expense of the health of the pupils. 

Air moisteners, therefore, are primarily for the purpose not 
of washing the air but of moistening the air so that it may be 
breathed with as little detriment as possible. This means that the 
outlying districts need air moisteners practically as much as the 
downtown districts need them. It has been argued that this appa- 
ratus is needed downtown only, as there the air is made impure by 
soot and dirt. 

—14— 



HEATING AND VENTILATING 15 

In the climate of Minneapolis no adequate method of wholly 
indirect heating has been found. It is necessary to reinforce the 
indirect system with direct radiation. This means the installation 
of radiators in the classroom. These must necessarily at times be 
within two or three feet of some of the pupils. When unprotected 
steam radiators are so located, a certain few children near them 
are being cooked and steamed all day, and almost sure chilling 
results when they leave this excessively high temperature for 
moderate temperature in the home or in passing through the cold 
air in going from the school to the home. 

It is now known that the installation of an asbestos-lined, 
steel shield, placed close to the radiator, protects the child from 
this direct radiation and makes the temperature of the nearest 
seat practically that of the farthest seat. No stringency of school 
funds should be permitted to exist which appears to make neces- 
sary the leaving off of these shields, which are such an efficient 
protection to the health and comfort of the children. 

Several years ago, it was found that fowl kept in warm poul- 
try houses did not thrive. Someone with sense removed the steam 
heat and the windows, placing in the window space a cheese cloth 
frame. Immediately the health of the fowl improved, and egg 
production was markedly increased. It was felt that similar treat- 
ment would probably be beneficial to children. In various cities 
at approximately the same time cheese cloth screens were put in 
the windows ; the windows were kept open, and the school room 
temperature was kept at approximately sixty degrees instead of 
seventy. 

The first room of that kind in Minneapolis was at the Whit- 
tier School in the school year 1911-12, with markedly beneficial 
results. The next year similar arrangements were made in sev- 
eral rooms in various parts of the city. As nearly accurate fig- 
ures as possible were kept upon these rooms, and the results in 
attendance compared with attendance of other rooms carried on 
under the ordinarily accepted methods of forced ventilation. 
These rooms contained pupils of approximately the same ages. 

The average number of days' absence per pupil in the open 
window rooms was 6%, while the average number of days' ab- 
sence in the control rooms was 8%. The average gain in weight 



16 KEEPING THE CHILDREN WELL 

in the open window rooms, from November 1 to May 1, was 
2.51 pounds ; the average gain in weight in the control rooms was 
1.47 pounds. Briefly, in the open window rooms there is approxi- 
mately 25 per cent less absence and approximately 75 per cent 
greater gain in weight. In another building, the amount of 
absence in a given room decreased by one-half after opening the 
windows. In addition to these figures, there is the testimony of 
the much more vigorous looks and feelings of both teacher and 
children. 

Because of these advantages, it has become the policy of the 
Board of Education to put into all additions and new buildings 
rooms which may be carried on as open window rooms, in the 
proportion of one of these rooms to each eight classrooms. 
The windows are pivoted, so that even the cheese cloth screen 
is not necessary, the pivoting of the windows preventing a direct 
draft. Additional radiation is installed, provision is made so 
that the ventilating of the room may be shut off from that of the 
rest of the building, and the temperature is maintained at about 
sixty degrees. These rooms are being received with great favor 
by pupils, teachers and parents. 

Some school districts have found fault because their chil- 
dren were compelled to attend the portable rooms which are 
placed sometimes adjacent to a main building, sometimes in iso- 
lated school sites. If the portable is properly handled, this appre- 
hension is wholly unnecessary. 

Practically all teachers in these portable buildings have had 
experience in teaching in large, artificially ventilated buildings. 
They report excellent sanitary conditions in the portables, where- 
as, as regards rooms in regular school buildings heated by fan 
ventilation, the teachers have reported about one-half as good 
or excellent. 

It is only fair to say, however, that in the regular buildings 
the ventilating is being rapidly improved. Attendance in the 
portables — and, other things being- equal, attendance is a fair 
index of the health conditions in a room — compared with the 
attendance in the buildings to which they are attached, shows in 
the majority of cases that there is less absence in the portable 
buildings than in the main buildings. It is also true that the ab- 




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18 KEEPING THE CHILDREN WELL 

sence from the portable buildings in isolated sites is less than 
absence from the nearest large building in the neighborhood. 1 

In the best of these portables the heating and ventilating is 
controlled by a jacketed stove. Cold, fresh air coming in about 
the base of the stove is heated inside the jacket. It rises to the 
top of the room where it gradually disperses, settles to the floor 
and is carried out through the foul-air duct. This jacket not only 
assists the ventilation, but prevents the heat of the stove from 
having an unhealthful effect upon the pupils seated near. 



!"The Effect of Conditions of School Room Heating and Ventilating on School At- 
tendance," C. H. Keene, Fourth International Congress on School Hygiene, Vol. II, 
page 243. 



Ill 

DRINKING WATER 



The drinking water problem has been a serious one. The 
modern bubbling fountain is a long way from the old wooden 
bucket half filled with stagnant water, with a solitary dipper at 
the bottom of the water. The progress in Minneapolis during the 
last few years has been from the big tank of spring water, with 
its half-dozen or dozen cups which were used promiscuously by 
the whole school, first to individual cups, then to room crocks 
with the use of individual cups under the direct supervision of 
the teacher, and finally to the bubbling fountain. There should 
be located, according to the state regulations, one fountain for 
each eighty pupils on a floor. Eleven schools, 16 per cent of the 
permanent grade buildings, fail to reach this standard. 1 

In selecting a type of bubbling fountain for use, one must 
be sure that the fountain is what it professes to be, a sanitary 
mechanism. Water contaminated by any previous user must be 
returned to the waste pipe instead of being held in a saucer-like 
arrangement, as happens with so many bubblers. 

As a matter of maintenance, watch must be kept constantly 
to see that enough water is flowing continuously so that no child 
needs to touch his lips to the bubbler itself in drinking. This 
means, of course, a large water waste, with a big water bill. 
Without this last provision, however, previous expenditures in 
purchase and installation of fountains are largely waste. 

Minneapolis city water is filtered and treated chemically so 
that it is perfectly safe to drink. 

!See monograph, A Million a Year, page 71. 

—19— 




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IV 



TOILETS AND FLOORS 



Toilets have presented another serious situation. The grad- 
ual bringing of most of them up to a proper standard has been 
a great drain upon the funds of the Board of Education. 

Until a few years ago it had apparently been the custom to 
make additions to buildings without adding to the toilets. The 
result in many cases was a sixteen or twenty-room building, with 
toilet capacity for eight or ten rooms. Of course, this condi- 
tion resulted in great confusion in toilet rooms, with crowded 
conditions, which certainly broke down the barriers of modesty, 
if not of morality. It probably also resulted in numerous ill- 
nesses coming about from children not using the toilets when 
they should. The present regulations call for a urinal stall for 
every fifteen boys, and a toilet stall for every twenty-five boys 
and one for every fifteen girls. 1 

The toilets have been largely remodeled, equipped with mod- 
ern, sanitary plumbing, painted in light colors, and provided with 
additional ventilating and window area. The mere painting in 
light colors had a wonderful effect on the moral atmosphere of 
many schools. Where previously, indecent inscriptions upon the 
toilets' walls were the vogue, now they are almost unheard of. 

Much thought and energy has been expended on the proper 
care of corridor and schoolroom floors. Even yet there is no 
unanimity of opinion. Some maintain that the use of oil on the 
floor is necessary to keep down the dust, others that the mere fact 
that the oil does keep down the dust makes it dangerous to use 
in classrooms, as the dust and dirt stays in the room instead of 
being removed by proper sweeping and washing. 

Changing from the old oak floors to maple has made a de- 
cided improvement in these conditions. Increased janitorial ser- 
vice also has permitted a better care of the floors than formerly. 



iThirteen schools, 19.5 per cent of the permanent buildings, fail to come up to the 
standard for boys' toilet stalls; twenty, 30 per cent, are deficient in urinal stalls, and 
eighteen, 27 per cent, fail to provide sufficient number of toilet stalls for girls. Mono- 
graph, A Million a Year, pages 66, 67 and 69. 

—21— 










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V 



LIGHTING IN CLASSROOMS 



A condition affecting through life the vision and health of 
the pupils is that of adequate lighting in classrooms. Factors 
in the lighting problem include location of windows — whether 
the light comes from the left or other direction, arrangement 
of windows, height of the window from the floor and its dis- 
tance from the ceiling. 

The consensus today demands that in rooms used for reg- 
ular classroom work, light should come wholly from the left, 
that the glass area should be not less than 20 per cent of the floor 
area, that the mullions between the windows, in order not to 
cast shadows, should be as thin as possible, that the windows 
should reach as near the ceiling as possible in order that pupils on 
the farther side of the room may get proper light. 

All this is merely a beginning. The expense up to this time 
is value or waste, depending upon the kind and arrangement of 
window shade which is installed. When the sun shines against 
the windows, it is necessary to draw the shades to prevent the 
sun's shining upon the pupil, page and blackboard, with a nerve 
and eye-destroying glare. 

The old, dark green, opaque window shade, when drawn 
down from a fixed roller at the top, resulted in a cave-like gloom 
which was absolutely ruinous, not only to vision, but to any class 
progress. At great expense, the Board of Education has grad- 
ually done away with these relics and installed in their places a 
modern, light tan, translucent shade, upon an adjustable roller 
fixture. It is possible to draw the shade and still have some fil- 

—23— 



24 KEEPING THE CHILDREN WELL 

tered light which adequately lights the room. An adjustable 
roller at the top ma}- be lowered a foot to eighteen inches, thus 
insuring a shaft of bright, unfiltered light. 

This change may account for the fact that the percentage 
of defects of vision found in the schools has decreased from 
18.1 per cent in 1911 to 15.4 per cent in 1916. 



VI 



SEATING OF CLASSROOMS 



Seating of the classroom has a direct bearing not only upon 
the child's comfort but upon progress and health, both in school 
and in after life. The old-fashioned school bench, a split log 
or plank upon four legs, was not markedly detrimental in the 
days in which it was first used, when the school year at the out- 
side was three months long and the child did work enough about 
the farm and home to offset any evil tendencies which his short 
time in school created. Now, when the child is in school five 
hours a day for nine or ten months, and his main activity is 
school, better provision must be made. 

If the seats are of uniform size, of a roomful of children 
of a given grade from 5 to 25 per cent, according to their ages, 
are too small for the seats in the room, and from 3 to 12 per cent 
are too large. This means that rooms must be seated in one of 
two ways — either by providing a sufficient number of adjustable 
seats, which can be raised and lowered to suit the size of any 
pupil, to care for these children whom the regular seats do not 
fit ; or by putting in enough different sizes of non-adjustable 
seats so that every child may be accommodated. 

The former plan is ideal in theory but hard to carry out, as 
the seats are often not adjusted. It is absolutely impractical 
when one takes into consideration the upper classes, where pupils 
are on a departmental basis and are in one room one period and 
in another room the next period. The plan of putting several 
sizes of seats in a room is much more satisfactory and less ex- 
pensive. Under this method, the child is almost never in a room 
that does not have a seat which is approximately fitted to his 
length of leg. 

—25— 



26 KEEPING THE CHILDREN WELL 

There has recently come a change in the type of seat, so 
that the seat itself is more nearly circular than the rectangular 
one, which was a survival from the old bench. In this the back 
more nearly fits the child's back instead of being curved in such 
a way as almost to force the child to slide down in the seat and 
rest on the end of his spine and the back of his neck. This 
method of using several sizes of seats the Board of Education 
for some time has been attempting to carry out. 

As is often the case in care of human beings, the schools 
are trailing along behind those who are carrying on some com- 
mercial enterprise. This has been true of the seating, so that 
the schools have at last arrived at the conclusion that a proper 
school seat closely resembles a proper chair for a stenographer, 
which has a round seat and a low back which supports the spine 
instead of crowding the shoulders forward. 



VII 

OPEN AIR SCHOOLS 



The first open air school in Minneapolis was started in a 
store building on the old Central High School site, in the early 
spring of 1911. Approximately twenty children were enrolled. 
The following year, when this store building was taken for other 
purposes, the school was not opened until February and was 
transferred to the George Bancroft building. 

During the year 1912-13, there were two of these open air 
schools. One was at the George Bancroft School, opened on 
October 28, with an attendance of twenty-four pupils. It occu- 
pied three rooms and toilet on the second floor. These facilities 
provided a rest room, dining room, bath and kitchen. The sec- 
ond school was opened in the Peabody building January 14, 1913, 
with an attendance of twenty- four pupils. Approximately the 
same facilities were provided as at the George Bancroft. 

During the school year 1914-15 these classes were trans- 
ferred to the Thomas Arnold School, which was an eight-room, 
unoccupied building, with a fairly large school site. Classes 
have been added gradually to the group until there are now 
accommodations for one hundred pupils. 

Children attending this school are selected from all over the 
city because of tubercular tendencies. None of them has an 
open, communicable case of tuberculosis. No case is contagious 
nor, in the present stage, is any child a menace to any of its 
neighbors. The session begins at 8:30 o'clock in the morning, 
at which time the children are given a breakfast of oatmeal and 
milk. A lunch is served in the middle of the forenoon, dinner 
at noon and another lunch in the afternoon just before dismissal, 
which is at 3 :30. 

—27— 




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The classrooms at the Thomas Arnold are provided with 
pivot-hung windows on two sides, the supply of fresh air being 
more plentiful where it is possible to have a room with windows 
on at least two sides. 

Each child has a rest hour in bed after the noon-day meal, 
and all the children that for any reason have a temperature or 
are not gaining in weight are required to rest for longer periods. 
All special subjects, except singing and physical education, are 
dropped from the curriculum of these children. Short periods 
of rest and work alternate through the day, one class reciting 
while another class is resting, playing games, and so on. 

Under such conditions, the progress of these children has 
been very satisfactory. Each year they have made an average 
gain per pupil of from 3^ to \]/ 2 pounds. Last year the whole 
group, with an attendance of 173 semesters, had a credit of 163 
promotions, 12 being graduated from the eighth grade. Four- 
teen during the last school year were returned to their regular 
grade schools as "arrested" cases. 

The rate of scholastic progress is as high as the rate in an 
average class of normal pupils. When one realizes that the pu- 
pils admitted to this school have all been diagnosed as having 
tuberculosis, although not in the open or contagious stage, the 
results are particularly gratifying. 1 



!See Appendix F. 



VIII 

THE PENNY LUNCH AND THE PENNY BREAKFAST 



For several years there has been considerable agitation in 
the city for the establishment of the penny lunch. Last year, 
under a committee representing the Woman's Club of Minneap- 
olis and the Fifth District of the Minnesota Federation of 
Women's Clubs, a really intelligent effort was made to work out 
this problem. 

This committee raised necessary funds 1 and managed the 
meals in four schools, the Clay, Washington, Nicollet and Van 
Cleve. In one building, the Clay, a penny breakfast was pro- 
vided ; in the three other buildings a penny lunch was provided 
in the middle of the forenoon, approximately at 10:30. 

The committee in charge, the school nurses and other edu- 
cational authorities are practically unanimous in holding that the 
penny breakfast is the proper thing to provide. This is partly 
on the theory that for the child who does not have a proper 
breakfast, the best time to give the breakfast is breakfast time 
rather than the middle of the forenoon ; and partly because of 
the results of last winter's work, the results at the Clay breakfast 
having been much more satisfactory than the lunch at the other 
schools. 

This year, as a result of the excellent results obtained by 
the committee, the work is being carried on directly under the 
charge of the Board of Education, financed, however, through 
the efforts of the same committee, and breakfasts are provided 
at four schools, the Clay, Holmes, Van Cleve and Washington. 

Everyone is quite convinced, too, that here, as in so many 
other fields of child hygiene, the success of this work depends 



1 See Appendix G. 

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very largely on the efficiency and humanitarianism of the school 
nurse. Great care must be observed in the selection of pupils, 
to see that only those pupils who actually need such lunch, and 
whose parents are unable to afford it, receive it. This experi- 
ment will be watched with great care, and every effort will be 
made to make it the success it deserves to be. 

The total cost of maintaining this school last year was ap- 
proximately $10,000, half of this being expended for ordinary 
school purposes, the balance for food and its preparation, for 
extra clothing, cots, blankets, and the like. 

Up to the beginning of the current school year, the Anti- 
Tuberculosis Committee of the Associated Charities has pro- 
vided the food and its preparation, clothing, cots, blankets, and 
so forth, while the Board of Education has provided the building 
and its care and heating, teaching, nursing and medical service. 
Beginning with the current school year, the Board of Education is 
taking over the full charge of this work, there being handed over 
to the Board for assistance in the work the sum of approximately 
$3,000, unexpended balance of the Anti-Tuberculosis Committee, 
which has raised the money for this purpose through these years 
from the sale of Red Cross seals. 



APPENDIX A 

HISTORY OF MEDICAL INSPECTION IN MINNEAPOLIS AND 

ELSEWHERE 



Medical inspection in schools is not a new thing. In France, as far 
back as 1833, the law directed school boards to keep the school houses 
clean, and in 1842 it was ordered that physicians visit the schools and 
inspect the children and the sanitation. 

Inspection was started in Brussels in 1874, and in Dresden and Leipsic 
in 1876. 

In Weisbaden a carefully thought-out plan was instituted, which has 
since become the prevailing German method. This plan includes examina- 
tion of eyes, ears, nose, throat, lungs, spine, heart, skin, and, in boys, for 
hernia. The results are made a part of the permanent record of the child, 
following him through school life. The height and weight are taken twice 
yearly, and whenever necessary another examination is made. A re- 
examination of all pupils is made in the third, fifth and eighth years of 
school life. Parents are notified of defects, and are expected to have them 
remedied. The school physicians do no treating. 

Hungary started in 1887, Norway in 1889, Sweden in 1863, Rumania in 
1899 and Russia in 1888. In 1908, England adopted its Medical Inspection 
Act, making such inspection a part of the compulsory duties of Boards of 
Education. Cairo, Egypt, has had medical inspection since 1882, Chili 
since 1888. The Argentine Republic is said to have the most complete 
and efficient system in existence, even including free medical advice to 
the teachers. Japan began in 1898. 

In the United States, the first public school medical officer was prob- 
ably in New York in 1892. Boston in 1894 started the first regular system 
of medical inspection, when the city was divided into fifty districts. New 
York made a real start in 1897, Chicago in 1895 and Philadelphia in 1898. 

At present only four states in the Union have no medical inspection 
at all. Only thirteen failed to make provision for physical examination. 
In 1915, there were 750 cities having medical inspection. 

Health supervision in Minneapolis was started several years ago on a 
voluntary basis, certain physicians giving their services for the purpose of 
visiting the school, with a view, almost entirely, to checking the spread of 
contagious disease. At that time, no nurses were used. As has been the 
history of all systems depending upon voluntary services, this supervision 
lapsed after a time. 

In the winter of 1909, a school nurse was employed by vote of the 
Board of Education. Payment of her salary was refused by the City 

—33— 



34 KEEPING THE CHILDREN WELL 

Comptroller on the ground that the Board of Education could not legally 
spend city funds for this purpose. Through the interest of the Woman's 
Club, the issue was taken through the courts, and in the fall of 1910 the 
Supreme Court handed down a decision affirming the judgment of the 
lower court that the Board of Education could so spend city moneys. The 
following is an excerpt from the Supreme Court opinion : 

"Education of a child means much more than merely communicating 
to it the contents of textbooks. But, even if the term were to be so 
limited, some discretion must be used by the teacher in determining the 
amount of study each child is capable of. The physical and mental powers 
of the individual are so inter-dependent that no system of education, 
although designed solely to develop mentality, would be complete which 
ignored bodily health. And this is peculiarly true of children whose im- 
maturity renders their mental efforts largely dependent upon physical 
conditions. It seems that the school authorities and teachers, coming 
directly in contact with the children, should have an accurate knowledge 
of each child's physical condition, for the benefit of the individual child, 
for the protection of the other children with reference to communicable 
diseases and conditions, and to permit an intelligent grading of the pupils. 
All of these considerations, as well as many others unnecessary to mention, 
convince us that the conclusions of the learned trial judge were entirely 
right." 

Following this stamp of approval by the highest court in the state, 
regular health supervision was started in January, 1911, with a corps of 
seven nurses and seven physicians. With this number it was found pos- 
sible to supervise the health of eighteen grade schools containing approxi- 
mate!}" twelve thousand pupils, about one-third of the grade school pupils 
of the city. 

This number of employees increased from year to year until in the fall 
of 1913 eight physiciens and twenty-six nurses were employed and for the 
first time special help and assistance could be given to all the pupils in the 
city. 



APPENDIX B 

WHY SCHOOL HEALTH SUPERVISION SHOULD BE CARRIED 
ON BY THE BOARD OF EDUCATION 



The question is sometimes asked, why is school health supervision, 
which on its surface seems primarily to be health work, carried on by the 
Board of Education instead of by the Board of Health? It is being asked 
in Minneapolis now because of the recent health survey here by a repre- 
sentative of the United States Public Health Service. Those advocating 
Board of Health control cite as examples certain of the large cities like 
New York and Chicago, and the fact that it is the duty of the Board of 
Health to prevent the spread of contagious disease. 

The reason for the first condition is that inspection was started ui 
this country first in the large cities, and when started, was purely a mat- 
ter of attempting to control contagious disease. Therefore, control was 
placed in the Board of Health. The later growth and scope of the work 
has entirely changed that condition, but many of these cities have con- 
tinued as they started. The answer to the second is that on the average 
in this city only about 5 per cent of the children have any contagious 
disease in any one school year. The work is primarily for the better edu- 
cational advancement of the whole 100 per cent, rather than for the control 
of the 5 per cent only. 

While in its infancy in this country the work was practically always 
put under Boards of Health, the trend away from that condition has been 
quite rapid. In 1912, only about 24 per cent of the school systems having 
health supervision permitted it to be under control of the Board of Health. 
In 1915, this number had been reduced to approximately 16 per cent. 

"Two gratifying tendencies appear in recent legislative and adminis- 
trative dealing with 'medical inspection' : the broadening of the scope of 
medical inspection, and the recognition of the educational department as 
the proper administrative authority. They are interdependent." This 
quotation is from the report of the United States Commissioner of Edu- 
cation, 1915. 

Broadening scope of the work, its gradual change from mere medical 
inspection into educational hygiene, has led inevitably to a recognition 
of the fact that the work should be wholly under control of the school 
authority. Of the states having special laws authorizing or compelling 
health supervision in the schools, only two directed it to be under the 
Board of Health. 

During the last two years, the argument of those holding that this 
work should be carried on by the Health Department, citing examples of 

—35— 



36 KEEPING THE CHILDREN WELL 

the large cities, has been badly shaken by the action of Congress in taking 
control in the city of Washington from the Board of Health, and plac- 
ing it under the Board of Education, and by similar action in the city of 
Boston. 

It is unfortunate that in America this work fell into the hands, origi- 
nally, of the health departments, thus emphasizing the medical side rather 
than the educational. Nowhere else in the world is it permitted to be 
under such control. All European and other countries carrying on such 
work place its control directly under the Board of Education. 



APPENDIX C 

RULES REGARDING SCHOOL PHYSICIANS 

The rules of the Board of Education regarding school physicians state : 

"a. They shall be graduates of a university or college, with at least 
two years' academic training and a degree of doctor of medicine, be 
graduated as an interne of one year's service from an accepted hospital, 
and shall be less than fifty years of age. 

"b. They shall be assigned to a group of schools and their hours shall 
be from 8 :55 a. m. to 12 noon each school day. 

"They shall visit each school in their charge at least once each week, 
according to schedule approved by the Director and at other times as 
required. Upon each visit they shall report immediately to the principal 
and leave written report of their work. 

"c. They shall examine each child referred to them by the principals 
for inspection, in a room set apart for this purpose, no other child being 
present. 

"d. They shall visit frequently the rooms of the schools to which 
they are assigned for the purpose of detection of cases of contagious dis- 
eases previously undiscovered, and to note the sanitary conditions of the 
building, but they shall not make any special examination of pupils in the 
classroom. 

"e. They shall make such report as the Superintendent or the Direc- 
tor requires. 

"f. They shall not offer their services or recommend other physicians 
for the treatment of public school children. 

"g. They shall not give treatment to a pupil except at the request, 
and in the presence, of the pupil's parent or guardian, except in case of 
accident or emergency." 



—37- 



APPENDIX D 

RULES REGARDING SCHOOL NURSES 

The rules of the Board of Education regarding school nurses state : 

"a. They shall be graduates of a general or children's hospital, and 
at time of appointment be between the ages of twenty- five and forty years. 

"b. They shall be assigned severally to a group of districts with hours 
from 8 :30 a. m. to 5 p. m. on school days, and 9 a. m. to 1 p. m. on Satur- 
days. 

"c. They shall wear the required uniform while on duty. 

"d. They shall receive all pupils referred by the school physician or 
principal in a room assigned for that purpose. 

"e. They shall give bath room service as directed, care for children 
who may be taken to a dispensary and visit the homes of the district as 
time will permit." 



-38— 



APPENDIX E 

DISTRIBUTION OF EXPENDITURE FOR HEALTH 
SUPERVISION IN 1915-16 

The $28,361 spent for health supervision in 1915-16 was divided as 
follows : 

$4,978 — physicians ; 
$19,268 — nurses ; 
$2,550 — bath attendants ; 

$250 — dental clinic; 
$1,315 — supplies. 

The salary of physicians varies from $600 to $650 a year, each physi- 
cian giving the Board of Education three hours each school day. The 
salary of nurses ranges from $625 to $900 a year for full time service. 
Bath attendants get $500 to $600. The school dentist is paid $3 for each 
afternoon employed. 



-39— 



APPENDIX F 

PROGRESS OF CHILDREN IN OPEN AIR SCHOOLS 

A table is here presented of the average gains in weight and scholastic 
progress of children in the open air schools from 1912 to June, 1916 : 

Average Gain Number 

Number in Weight Promotions Number 

Date Enrolled in Pounds During Year Discharged 

1911-12 22 4V 2 No record 

1912-13 25 3.32 No record 

1913-14 .63 (5 months) 2.04 68 1 

1914-15 Ill (7 months) 2.23 185 8 

1915-16 106 4.46 163 14 



—40- 



APPENDIX G 

FINANCIAL STATEMENT OF PENNY LUNCHES 
FOR 1915-16 

Disbursements 
Help— 

November $33.90 

December 57.00 

January 60.50 

February 58.50 

March 75.00 

April 32.25 

Total $317.15 

Supplies — 

November — No bills paid. 
December — No bills paid. 

January $55.34 

February 197.79 

March 184.21 

April 142.05 

Total $579.39 

Grand Total $896.54 

Receipts 

November 1— Balance $213.03 

School collection 208.38 

Pennies 1 270.24 

Woman's club 100.00 

Fifth district 35.00 

Parents' and Teachers' organization 93.49 

$920.14 



Balance penny lunch $23.60 

Balance garment section .07 

Balance on hand $23.67 



iReceipts in pennies by months were: December, $51.53; January, $38.77; Feb- 
ruary, $43.99; March, $107.03; April, $28.92. Total, $270.24. 



—41— 



A SERIES OF MONOGRAPHS 

(Continued from inside front cover) 

10. Teaching in Minneapolis. 

Conditions of appointment, retention and ad- 
vancement; salaries; expenses; advantages. 

Ready, January, 1917 

11. Making Children Strong. 

Athletics, plays and games, gymnasium work. 

Ready, February, 1917 

12. Housing the Children. 

School buildings, * old and new; different types; 
additions; remodeling and repairing; grounds, 
equipment. 

Ready, February, 1917 

13. Becoming Professional. 

Professional organizations of ^teachers; work at 
the University of Minnesota; "extension" work; 
research in the schools; summer school study. 

Ready, March, 1917 

14. Why Summer Schools? 

Ready, March, 1917 

15. Children Who Are Different. 

Defectives, subnormals and backward pupils; pro- 
visions made for them. 

Ready, April, 1917 

16. Something About Minneapolis Kindergartens. 

Ready, April, 1917 
17; The Critical Period. 

Junior High Schools. 



18. The Parting of the Ways. 

Senior High Schools. 

19. After the Day's Work, 

Minneapolis Evening Schools. 



keady, May, 1917 
Ready, May, 1917 
Ready, June, 1917 



20. Possibility and Opportunity. 

Vocational guidance, placement and supervision. 

Ready, June, 1917 

Other monographs in preparation ; titles and dates of pub- 
lication to be announced from time to time. 

Monographs are uniformly 6x9, printed on good paper and 
illustrated with charts, diagrams and photographs. Price, 
single copies, 25 cents; ten or more copies to one address, 10 
per cent discount, postage paid. One hundred or more copies 
to one address at 25 per cent discount, transportation to be 
paid by the purchaser. Address, Secretary to the Superinten- 
dent of Schools, 305 City Hall, Minneapolis, Minn. 



LIBRARY OF CONGRESS 




022 124 140 A 



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